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1 (a) Is there a EHD contractor's and subcontractor's questionnaire on file or enclosed9 YES NO [] <br /> (b) Is the current certificate of worker's compensation insurance on file9 YES 6d NO [] <br /> (c) Does the contractor possess a"Hazardous Substance Removal Certification". YES�J NO [] <br /> (d) Has everyone on site, including crane/backhoe operator, been certified to work on <br /> (e) hazardous waste site in accordance with CCR Title 89 YES [X] NO [] <br /> 1 2 Has a"Site Health & Safety Plan"for this fob site been submitted9 YES kL NO [] <br /> 3 Has applicant performing removal in the City of Tracy obtained a"Grading and Excavation Perrn;t"9 <br /> ' NIA;K YES [I NO [] If YES, Permit# <br /> 4 Has the contractor obtained approval from the local fire department to perform tank cutting9 NAY] YES[ ] <br /> ' NO[] <br /> 5 Is there knowledge or evidence of leakage from the tank(s) and/or piping9 (If yes, please explain) YES <br /> NO [I <br /> _mLot 1.4 fa <br /> ' 6 If tank residual exists, identify transporting hazardous waste hauler <br /> Name kamcs r vl_c,G Hauler Registration#2EIK <br /> ' Address �S� ac Cti ,F r►' f'�-x(,A City VAL f sa"-z^0 +0 Zip <br /> Phone# ( I� __-) , �1-5-7- i <br /> 7 Decontamination Procedures. <br /> a Will tank(s) and piping be decontaminated prior to removal9 YES K NO [] <br /> b Identify contractor performing decontamination <br /> Name !=n a r'on Pn4,tfP7 fnr, t Gcm E rczd 1 q C <br /> Address—51-2i r s d t- City 4'4nf, Zip <br /> ' Phone No (t.4 ) (26 7`X.304 <br /> c Describe method to be used for decontamination <br /> fra / erns <br /> ' d Describe how rinsate material will be stored onsite prior to manifesting offsite <br /> e Rinsate Hauler and permitted Treatment, Storage & Disposal Facility <br /> Hauler Name 9�ta eyio_S Louiran.ne-,,? 7V 5 ­Jtcf5 Hauler Registration# <br /> ' Address r/6J ' Cit swtsf Zip9SE�S <br /> Phone No { )_ - S72 - —- <br /> Permitted Disposal Site g. mor=, Sar wlcM,; _ <br /> EH 23 046 (Revised 3115/02) Page 4 <br /> 1 <br />